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Pregnancy and STDs

pregnancy

You probably haven't thought about STDs since your carefree college days, but here's one sobering reason to think about them now: about two million pregnant women harbor STDs such as herpes or chlamydia, according to the Centers for Disease Control (CDC). Many have no clue that they have these diseases, but if left untreated, the infections can harm both you and your unborn baby. That being said, there's no reason to panic. There is every reason to be tested, so you can take steps to protect yourself and your baby. Here, the scoop on five common STDs.

Herpes

What it is: An STD caused by the herpes simplex virus (HSV). Most cases of genital herpes are due to HSV-2, although some may be caused by HSV-1, the virus that typically causes cold sores. About 25 to 30 percent of pregnant women have the herpes virus, according to the American Social Health Association (ASHA), but only 5 to 10 percent have had active outbreaks of blisters or sores around their vagina and buttocks.

Why it's dangerous: Less than 0.1 percent of babies born in the United States contract herpes, according to the ASHA, which is reassuring. But those who do get the virus suffer severe consequences: neonatal herpes can damage the central nervous system, cause mental retardation, and even cause death. "Your baby is most at risk if you contract genital herpes while you're pregnant -- because you're newly infected, you don't have any antibodies to the virus, so you can't pass them on to your baby for protection," explains Lisa Hollier, MD, MPH, associate professor of obstetrics and gynecology at the University of Texas in Houston. In addition, if you have a first-time outbreak at delivery, the risk of transmission is anywhere from 30 to 60 percent.

Should you be tested? If you've never shown signs of a herpes infection, probably not. Groups like the American College of Obstetricians and Gynecologists (ACOG) currently don't recommend routine HSV screening of pregnant women. "Many women who test positive for the virus are unaware that they even have it because they had a very mild case that never presented symptoms," Dr. Hollier explains. "We don't want to alarm them unnecessarily, because the risk of passing it on to their babies is very, very low." The one exception: if your partner has herpes, it's recommended you take a blood test to see if you have antibodies from a previous infection. If you're negative, it's recommended you use condoms throughout the pregnancy and abstain from sex if he's having an active outbreak.

Treatment: If you've had herpes outbreaks in the past, be prepared for another bout, as about 75 percent of these women experience at least one recurrence during pregnancy. Ask your doctor about trying a suppressive treatment, such as valacyclovir during your last month of pregnancy -- a 2006 study found it decreased the rate of outbreaks at delivery by 69 percent. If you have no signs of an outbreak, it's safe to have a vaginal delivery.

What it is: An imbalance of bacteria in your vagina. It's the most common vaginal infection in women of childbearing age. In the U.S., as many as 16 percent of pregnant woman have BV, according to the CDC.

Why it's dangerous: It increases your risk for preterm labor and birth, says Paul Nyirjesy, MD, professor of obstetrics and gynecology at the Drexel University College of Medicine, in Philadelphia. A 2002 study also found that women with BV were about 20 percent more likely to suffer a miscarriage in their second trimester.

Should you be tested? Experts don't recommend screening all pregnant women unless they have clear symptoms, such as a strong fishlike odor and/or a thin white or gray discharge. "Research shows that treating women who are symptomless doesn't reduce risk of premature delivery," explains Patrick Duff, MD, professor and residency program director in the department of obstetrics and gynecology at the University of Florida, in Gainesville. The one exception? Women with a history of giving birth prematurely should be tested.

Treatment: A seven-day course of the oral form of the antibiotic metronidazole (Flagyl).

What it is: An STD caused by the bacterium Chlamydia trachomatis, which, if untreated, can spread into the uterus or fallopian tubes and cause fertility-threatening pelvic inflammatory disease. An estimated 2.8 million Americans are infected each year -- including 200,000 pregnant women -- according to the CDC. Even scarier, about 75 percent of those women don't have symptoms like vaginal discharge or pain while urinating, so they have no clue they're infected.

Why it's dangerous: You can pass chlamydia to your baby during delivery, and she can develop pneumonia as a result. This can be fatal for a newborn, says Miriam Greene, MD, an ob-gyn at New York University Medical Center.

Should you be tested? Absolutely -- the CDC recommends that all pregnant women be screened at their first prenatal visit.

Treatment: If you've got chlamydia, both you and your partner will be treated with the antibiotic Zithromax, says ob-gyn Wendy Wilcox, MD, medical director at Montefiore Medical Center, in the Bronx, New York. You should abstain from sex until you've both completed treatment, so you don't get reinfected. Your doctor should also repeat the test during your third trimester, to make sure you're not infected during delivery.

What it is: An infection caused by a single-celled parasite known as Trichomonas vaginalis. Estimated to affect 80,000 pregnant women each year, trich is the most common STD among women.

Why it's dangerous: Trichomoniasis infection during pregnancy is linked to a higher risk of premature delivery and to preterm premature rupture of the membranes (PPRM), Dr. Nyirjesy says. It can also make you more susceptible to other STDs, like chlamydia and HIV, if you're exposed to them.

Should you be tested? Only if you experience the symptoms: yellowish, greenish, or grayish vaginal discharge, often accompanied by an unpleasant odor. "There's no evidence that treating symptomless trich lowers your risk of preterm delivery, and even some evidence that it may actually increase it," Dr. Nyirjesy explains.

Treatment: Both you and your partner will be treated with Flagyl. Even if your partner doesn't have symptoms -- and most men don't -- he'll need to be treated so you can avoid reinfecting each other. You'll also have to abstain from sex until you've both completed treatment.

What it is: A genital infection due to a group of viruses. There are about 100 different strains, more than 30 of which are sexually transmitted and can infect your vagina, cervix, or butt, or your partner's penis. Of these 30 strains, about 15 have been linked to cervical cancer, and two have been linked to genital warts. It's the most common STD in the U.S. About 75 percent of men and women will be infected with genital HPV at some point, but most don't know it because they have no symptoms and the infection clears up on its own.

Why it's dangerous: If you've got the type of HPV linked to cervical cancer, there's little to no risk of it passing to the baby, Dr. Duff reassures. If you have genital warts, they may grow faster in pregnancy, probably due to a slight depression in your immune system, Dr. Greene says. But the risk to your baby is small, and you can usually deliver vaginally.

Should you be tested? No, but if you've ever developed warts or had an abnormal Pap, tell your doctor so she can monitor you more closely during pregnancy, Dr. Duff advises.

Treatment: If you have a history of abnormal Paps, your ob-gyn will most likely monitor you closely with repeat smears every three to six months. If the results are abnormal, she will perform a colposcopy, examining your cervix under a microscope and doing biopsies of any suspicious areas. If you've got precancerous or low-grade cancerous cells, your doctor will probably opt to wait until after you give birth for treatment, instead of just following you carefully with colposcopies, Dr. Wilcox says. If you've got a more developed cancer, you'll need more invasive treatments such as surgery. Chances are, your doctor will wait until after your pregnancy to treat your genital warts -- unless they get really big, in which case she may remove them by laser or surgically. "Oftentimes, the warts, even if they're large, will disappear on their own after a woman gives birth and her immune system returns to normal," Dr. Greene says.

What's Going on Down There?

If you have... An odorless or mild-smelling milky discharge
It's probably... Leukorrhea, a discharge made of secretions from your cervix and vagina.
What to do... Let your doctor know about it at your next appointment (yes, it can wait) -- she may want to examine you to rule out other vaginal infections like BV.

If you have... Itchy pimple-like lesions on your butt
It's probably... Pruritic urticarial papules and plaques of pregnancy (PUPPP), a rash that may develop in pregnant women, often in the third trimester.
What to do... Show your rash to your doctor at your next visit -- she'll probably prescribe topical medicines like steroid creams and/or an antihistamine.

If you have... Vaginal itching and/or burning
It's probably... A yeast infection (especially if it's accompanied by a thick and cheesy discharge) or a mild rash due to the vaginal swelling that occurs in pregnancy.
What to do... Call your doctor. She'll probably still want to see you to rule out an STD like trich or BV. If it's a yeast infection, she'll prescribe a topical cream or recommend an over-the-counter treatment. Wearing cotton underwear and soaking once or twice a day in an oatmeal milk bath may bring relief.



Copyright © 2008. Used with permission from the April 2008 issue of American Baby magazine.


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